410 NE 102 St (6)BUILDING
ELECTRICAL
PLUMBING
Owner of
Building
Architect
'Contractor
or Builder
MIAMI SHORES VILLAGE, FLORIDA
DATE
PERMIT N9 3530 Contractor's
License No.
Subdi-
vision
Value of
Project
_ F
Work to be performed under this Permi4 - "A- .- n �
fiTs Construction he in wola
Vlfs( piodustion Board Ge:ier31 Limitations tJ.
You are (Lollard to rnnsillt your War P.ol p_ .a;
Bob; d office beforQ starting the werk eutiAri e6 i .
this permit,
t L gal Lot Bl.
D scripti.on
Address of }}� � f t r
Building °' ' n r
This permit is granted to the contractor or builder named above to construct the building or to install the equipment or device described in the
application herefor in strict compliance with all ordinances pertaining thereto and with the understanding that the work will be performed in compliance
with any plans, drawings, statements or specifications that may have been submitted to and approved by the proper municipal authorities. This Permit may
be revoked at any time if the work is not done in compliance with such ordinances or if the plans are changed without authorization. A further condition
upon which this permit is granted is the understanding that the contractor or builder named above assumes the responsibility for a thorough knowledge of
the ordinances and regulations pertaining to the work covered hereby whether shown on the plans or drawings or in the statements or specifications and
that he assumes responsibility for work done by his agents, servants or employees.
Signed: By A
INSPECTOR
In consideration of the issuance to me of this permit I agree to perform the work cr &d hereunder in compliance with dinances and AF
tions pertairiYn thereto and in strict conformit with the plans, drawings, statements or pgei'fications submitted to the proper au ties of Miami h e
Villager In a cepting.this e rm assume responsibility for all work done by either mysellf, my agent, servant or employee.
mil
CONTRACTOR OR BUILDER
Amt. of
Permit
BY AUTHORITY
194"'+
Application is hereby made for the approval of the detailed statement of the plans and specifications herewith submitted for the building
or other structure herein described. This application is made in compliance and conformity with the Building Ordinance of Miami Shores
Village, Florida, and all provisions of the Laws of the State of Florida, all ordinances of Miami Shores Village and all rules and regula-
tions of the Building Division of Miami Shores Village shall be complied with, whether herein specified or not. A copy of approved plans
and specifications must be kept at building during progress of the work.
Owner's Name and Address W��L f .M 1701 -p S 7:41(18
Registered Architect and /or Engineer
Name and address of licensed contractor
Location and legal description of lot to be built on: -
Lot____ _,__ __ Block_______ —_ Subdivision
Street and Number where work is to be done W O tih e. // S7
State work to be done and purpose of building (by floors)
Ce"4'(_1 -46 CL. 3
New Building Remodeling_______________ Addition__________ —___ Repairs
To be constructed of a $_____ Kind of foundation
Estimated Total cost of improvements $_____— _________________.Amount of Permit $
Zone cubage required— —_Plan Cubage
Distance to next nearest building
Maximum live load to be borne by each floor
I hereby submit all the plans and specifications for said building. All notices with reference to the building and its construction may
be sent to
STATE OF FLORIDA,
COUNTY OF DADE.
Permit No.__ Date
Disapproved Date
(Signed i�
f ,/.(
MrAPfl SHORES VILLAGE
JILDING INSPECTION DEPARTMENT
APPL 2 ATION FOR BUILDING PERMIT /.
Size of Building Lot
Read, Sworn to and Subscribed before me.
Building Inspector My Commission Expires ____--
L .•
and for no other purpose.
No. of Stories__
Covering___— _— _______
The undersigned applicant for this building permit does hereby certify that he understands and accepts his obligations as an employer
of labor under the Florida Workmen's Compensation Act, being Section 5966, Compiled General Laws of Florida, Permanent Supplement.
and has complied with the provisions thereof, and will require similar compliance from all contractors or sub - contractors employed by him
in the work to be performed under this permit: and will post or cause to be posted for inspection on the site of the work such public notice
or notices as are required by the Act. The undersigned agrees to employ only such su• actors on work to •e .erformed under this
permit, as are licensed by Miami Shores Village.
Remarks (Signed) ..././
Before me, the undersigned authority, a notary public, duly authorized to administer oaths and take acknowledgments, personally
appeared
and who, being by me first duly sworn, upon oath deposes and says that he is the
of the above described construction, that he has carefully read the foregoing application, and that he did sign the same, and that all facts
therein by him stated are true.
Notary Public, State of Florida
PLANNING BOARD DATE
Chairman « Member
Member Member
Member Member
Council Approved Date Disapproved
to me well known,
__Date
NOTE: A charge of $1.00 will be made for making corrections or changes to this application after approval has been obtained from
the Planning Board.
A re- inspection fee of $1.00 will be charged when such re- inspection is made necessary by improper notice for inspection or faulty
- materials and/or workmanship.